Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.
Cervical stenosis can be a difficult clinical condition to treat effectively, and treatment may be followed by recurrences. Thirty-seven (37) women with this clinical diagnosis were evaluated and treated in our service over the last 5 years. Fifteen (15) women (43.2%) had previous cervical surgery such as conization, loop electrosurgical excision procedure (LEEP), or cervical laser vaporization and 11 had a history of diethylstilbestrol (DES) exposure. After treatment, 28 (75.5%) of these women obtained relief while in 24.5% no changes occurred. Four women (14.2%) had recurrence. Based on our experience, sequential progressive cervical dilatation under sonographic or laparoscopic control seems to add safety and effectiveness in the treatment of this condition. For those patients who develop recurrences, laser removal of a cervical central cylinder of tissue seems to provide the best results. Avoiding excessive trauma to the cervix with any surgical procedure should be paramount in decreasing chances of causing cervical stenosis, particularly in susceptible patients such as nulliparous and DES-exposed women. (J GYNECOL SURG 18:129)
There has been an increasing trend in Laparoscopic surgeries. There is also a higher incidence of patients with ventriculoperitoneal (VP) shunts due to the advances in the techniques of cerebral shunts. Surgeons may come across patients of VP shunts presenting with an indication for laparoscopic surgery. Although there is no absolute contraindication for laparoscopy in VP shunts, there is always a risk of raised intracranial pressure. We describe a case of VP shunt presenting with an ectopic pregnancy and undergoing laparoscopic salpingectomy. Patient withstood the procedure well and had an uneventful recovery. Reviewing the literature, we found that laparoscopy is safe in VP shunts. However, there should always be accompanied by good monitoring facilities.
Three-dimensional trans abdominal volume studies of the fetal brain show promise for the diagnosis of structural anomalies of the developing brain. However, technological improvements in the quality of resolution will be required for this technique to be incorporated into routine clinical practice.
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